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Med. J. Cairo Univ., Vol. 79, No. 1, September: 509-517, 2011 www.medicaljournalofcairouniversity.com

Comparison between Body Image and Self-Esteem Among Female Nursing Students in Three Different Arab Countries

NABILA TAHA, D.N.Sc.*; ESSMAT MANSOUR, D.N.Sc.**; AMAL SOBHY, D.N.Sc.*** and ENTISAR M. YOUNESS, D.N.Sc.*

The Departments of Obstetrics & Gynecological Nursing*, Faculty of Nursing, Assiut University; Medical Surgical Nursing**, Tanta University and Psychiatric & Mental Health Nursing***, Port-Said University.

Abstract

Current western culture promotes standards of beauty and success which focus on physical attractiveness. These standards can create feeling of inadequacy and body dissatisfaction. Traditionally, women have responded most strongly to cultural messages of bodily attractiveness, there by experiencing greater body dissatisfaction than men. Failure to achieve the ideal has been shown to lead to decreased self-esteem which compounds body dissatisfaction and body image disturbance. Therefore; this study aimed at assessing and comparing the level of body image and self-esteem among three communities based sample from Riyadh- Kindom of Saudia Arabia (KSA), Hadhramout-Yemen, and Assiut-Egypt, 300 female students were recruited, 100 female students from each country. The study was carried out in three different settings; Riyadh Female Health Science Collage-KSA, and Faculty of Nursing, Hadhramout University of Science and Technology-Yamen, Faculty of Nursing, Assiut University-Egypt. Tools for data collection included; body image scale, which developed by El-Desouki. This scale consisted of 20 statements about positive and negative sensation of body image, Rosenberg self-esteem scale, this scale consisted of 10 statements about the positive and negative sensation of self-esteem and interview Questionnaire which developed by the investigators, it includes information about student's age, residence, marital condition, economic condition, parent's educational level, number of brothers and sisters and their orders among them. Results of this study revealed that positive body image constitutes 86% in KSA, 84% from Egypt while 73% from Yemen. The majority of the students in the three countries had high self esteem (78% in KSA, 96% in Egypt and 84% in Yemen). The study also found that positive perception of body image is associated with high self esteem (85.9%, 84.8% and 69.0%) among the studied students’ in KSA, Egypt and Yemen respectively), fortunately; negative perception of body image is associated with low self esteem in (13.6%, 15.2% and 6.2%) among students’ of KSA, Egypt and Yemen respectively. In conclusion high level of self esteem positively correlated with body image. Age, parent’s education, marital status, numbers of brothers and sisters are significantly correlated to body image and self esteem. This study recommended another informative

Correspondence to: Dr. Entisar Mohammad Youness Lecturer Obstetrics and Gynecological Nursing, Faculty of Nursing, Assuit University, E. mail: [email protected]

study to investigate other dimensions of body image and self esteem in multi dimensional settings and studying the healthy lifestyle choices which are also a key to improve body image.

Key Words: Body image – Self esteem – Body image scale – Self esteem scale – Female nursing students.

Introduction

IN the light of the sudden and rapid changes in physical growth and psychological development among adolescents it was reported that body image related problems have become a critical determinant of nutritional status that place adolescents, partic- ularly girls, as one of the nutritionally vulnerable groups. Evidences have shown that negative body image is significantly linked to various health issues, including a spectrum of disordered eating, low self esteem, depression and unhealthy weight- loss practices [1,2] .

Body image is the person's perception of his or her physical self. This perception includes con- scious and unconscious perceptions of physical attributes and functioning, emotions, and sensation, it extends beyond the body to include objects such as clothing or items used in work [3] . A person's body image forms and changes as he or she devel- ops, and is closely tied to self esteem and identity, both of which are threatened by a change in body image. Body image also is influenced by cultural beliefs and values and massages one receives from others [4] .

Body image is changed as one progress through the different developmental stages of life. Persistent preoccupation with one's body image can impair emotional and cognitive development, interfere with interpersonal relationships, and place an individual at risk for the development of an eating disorder [5] . Any change in body image has de- stroyed all of his or her strengths. The client may

509

510 Comparison between Body Image & Self-Esteem Among Female Nursing Students

feel incapable of succeeding at anything and may need encouragement to attempt activities. Activities within the client's abilities provide opportunities for success. Positive feedback can enhance self esteem. Clients with low self esteem don’t benefit from flattery or undue praise [3] .

Negative body image is a serious issue during adolescence and should be duly addressed. Al- though body image has been increasingly studied over the last half century, no consensus was found in the definition of the body image concept. How- ever, body image scholars [6] had agreed that body image comprises a multi-dimensional construct with various dimensions. One of the most common dimensions that have been described is body dis- satisfaction, which is used interchangeably with negative body image or body image disturbance. Overlooking in the body image concept and failure to distinguish the various dimension of body image may hinder the important role of body image in population health and well-being. So, a thorough understanding of the body image concept is crucial in determining the etiology, prevention and treat- ment of body image and its related problems, particularly eating disorders and obesity [7] .

As body image encompasses a complex and multi-dimensional construct, [8] recommended that multi scales should be used to assess body image. However, this may raise the issue of whether the items of the scales are overlapping to the point of redundancy.

With a positive or healthy body image, a woman has a real perception of her size and shape. She also feels comfortable with her body. With a neg- ative body image, a woman has a distorted percep- tion of her shape and size, compares her body to others, and feels shame and anxiety about her body. Being unhappy with your body can affect how you think and feel about yourself as a person. A poor body image can lead to emotional distress, low self-esteem, unhealthy dieting habits, anxiety, depression, and eating disorders. Developing a positive body image and a healthy mental attitude is crucial to a woman's happiness and wellness [3] .

Aim of the study: The aim of this study was to assess and compare

the level of body image and self esteem of the female nursing students in three different Arabic countries (Saudi Arabia, Egypt and Yemen).

Research question: What are the differences between the level of

body image and self-esteem among female nursing students in the three different Arab Countries?

Subjects and Methods

Research design:

Comparative research design was utilized in this study.

Settings:

The study was carried out in three different setting; Faculty of Nursing, Assiut University, Egypt, Riyadh Female Health Science Collage, Kingdom of Saudia Arabia, and Faculty of Nursing, Hadhramout University of Science and Technology, Yemen. These faculties are governmental faculties (Ministry of Higher Education), and encompass multi-residential studies.

Subjects:

Subjects consisted of 300 female nursing stu- dents from three different Arab Countries, 100 students from each one. Their age ranges between 18 and 30 years. As the study involved only ado- lescent girls, the sample is limited by sampling location whereby these girls had became physically and psychologically mature, so all subjects were from the second year students in the three faculties which involved on the average of 100 female students.

Tools of data collection:

Data were collected using a self-administered questionnaire which has been translated into Arabic language.

Three tools were utilized in this study: 1- Interview questionnaire:

It includes information about socio–demograph- ic characteristics such as student's age, residence, marital status, economic status, parents’ educational level, number and orders of brothers & sisters.

2- Body image scale:

Body image scale which was developed by El- Desouki [9] were used to assess students’ body image. This is a factorial derived measure of male and female body esteem. This scale consisted of 20 statements about positive and negative sensation of body image. For example “I accept my shape as it is”. Items were rated on a five-point Likert scale, from strongly negative feelings to strongly positive feelings. Each scoring response is classified to 1-5 degrees: 1 for never, 2 for rare, 3 for some- times, 4 for mostly, 5 for always. In total score for each student the high score indicates positive body image and the low score indicates negative body image.

Nabila Taha, et al. 511

3- Self-esteem scale: Self-esteem was assessed through using a

Rosenberg self-esteem scale (1965) [10] ; this scale consisted of 10 statements about the positive and negative sensation of self-worth, an example of which is “I feel that I have a number of good qualities. There were five positive statements and five negative statements, with four-point Likert scale ranging from ‘strongly agree’ to strongly disagree” Each scoring response is classified to 1- 4 degrees. 1 degree is assigned for strongly agree, 2 degrees for agree, 3 degrees for disagree, and 4 degrees for strongly disagree. In total score for each student the high score indicates high self- esteem and the low score indicates low self-esteem.

study. No health hazards were present. Participants were assured that all their data are highly confi- dential, anonymity was also assured through as- signing a number for each student instead of names to protect their privacy. Data was only available to the researchers and the participants.

Statistical analysis: Collected data were coded and analyzed. De-

scriptive statistics for the variables were calculated. Variables were compared using chi-square test. The variables were significant at p-value <0.05. All the statistical analysis was performed using SPSS package version 11.

Results Content validity:

It was established by panel of 5 experts who reviewed the instruments for clarity, relevance, comprehensiveness, understanding, applicability and easiness.

Pilot study: A pilot study was conducted on 10 students

from each country, to test feasibility of tools and time required to be applied. Simple modification was done of some items of the interview question- naire sheet that they were not consistent with this study.

Administrative design: Before the conduction of the pilot study as well

as the actual study, an official permission was obtained from the dean of each collage in each country.

Procedure: The official permission was obtained from the

research ethical committee in the three nursing faculties in the three countries to approve this study. The students were gathered in the faculty class for each session of data collection. An infor- mation sheet explaining the study purpose and its protocol was disseminated and explained before informed consent was obtained from the students. Data were collected using a self-administered questionnaire and the tools utilized to collect the desired data were explained sufficiently. The stu- dents were interviewed in groups, 25 students in each session in their classes for about 20 minutes. The duration for data collection lasts for 3 months precisely from April to June, 2010.

Ethical consideration: The study protocol was approved by pertinent

research and ethical committees. Informed consent was taken from every girl before inclusion in the

Table (1) Describes the socio-demographic characteristics of the students. It shows that 91%, 68% and 88% of the students were in the age group from 20 to less than 25 years in KSA, Egypt and Yemen respectively. Most of mothers and fathers education in three countries had basic education. There is a highly statistical significant difference between the three countries regarding age (X 2= 41.774, p=0.000) and mother’s education (X 2= 18.78, p=0.005) while there are no statistically significant differences between them as regards father’s education (X 2=9.006, p=.170).

Regarding mother’s job, the majority of mothers in the three countries were housewives (73%, 77% and 89%) in KSA, Egypt and Yemen respectively. In relation to place of residency, it was found that 93% of students in KSA, 35% of students in Egypt and 87% of students in Yemen are coming from urban areas and the majority of students had inter- mediate family income in the three countries (79% from KSA, 92% from Egypt and 61 % from Yemen). There is a statistical significant difference between the three countries regarding mother’s job (X 2= 8.560, p=0.014), place of residency (X 2=100.202, p=0.000) and family income/month (X 2=56.434, p=.000).

Also Table (1) represented that about half of the females had from 1-3 brothers and sisters (51%, 52% and 46%) and more than half of them in the medium of birth order (57%, 55% and 56%) in KSA, Egypt and Yemen respectively. Regarding marital status, about one quarter of the students in KSA (24%), only 3% of students of Egypt, while 86% of Yemen were married. There is a highly statistical significant differences between the three countries regarding number of brothers and sisters (X

2 =26.775, p=0.000), marital status (X 2=161.041,

p=0.000) while there is no statistically significant

512 Comparison between Body Image & Self-Esteem Among Female Nursing Students

differences between them regarding birth order (X2=.648, p=.958).

Distribution of the study sample according to their self esteem represented in Table (3), the subjects were grouped according to their scores of the level of self esteem into two groups (low and

high self esteem). The majority of the students in the three countries had high self esteem (78% in KSA, 96% in Egypt and 84% in Yemen) while the rest of subjects had low self esteem (22% of KSA students, 4% of Egypt students and 16% of Yemen students) with a highly statistically significant difference (X

2 =13.953, p=.001).

Table (1): Distribution of the subjects according to their socio demographic characteristics.

Country Socio-demographic

characteristics KSA (100) Egypt (100) Yemen (100) Total (300) Chi-Square

Test p-value

N % N % N % N %

Age (years): <20 4 4 32 32 7 7 43 14.3 20- 91 91 68 68 88 88 247 82.4 41.774 .000 25-30 5 5 0 0 5 5 10 3.3 S

Mother’s education:

Illiterate 20 20 28 28 21 21 69 23.0 Basic 36 36 32 32 53 53 121 40.4 18.787 .005 Secondary 20 20 28 28 13 13 61 20.3 S University 24 24 12 12 13 13 49 16.3

Father’s education:

Illiterate 11 11 13 13 6 6 30 10.0 9.006 .170 Basic 34 34 31 31 38 38 103 34.3 N.S Secondary 28 28 30 30 40 40 98 32.7

University 27 27 26 26 16 16 69 23.0

Mother’s job:

Housewife 73 73 77 77 89 89 239 79.7 .014

Employed 27 27 23 23 11 11 61 20.3 8.560 S

Place of Residency:

Urban 93 93 35 35 87 87 215 71.7 100.202 .000 Rural 7 7 65 65 13 13 85 28.3 S

Family income/month: High 5 5 0 0 31 31 36 12.0 Intermediate 79 79 92 92 61 61 232 77.3 56.434 .000 Low 16 16 8 8 8 8 32 10.7 S

Number of brothers & sisters:

Null 3 3 0 0 2 2 5 1.7 1-3 3 3 23 23 25 25 51 17.0 26.775 .000 4-6 51 51 52 52 46 46 149 49.6 S More than 7 43 43 25 25 27 27 95 31.7

Birth Order:

First 24 24 23 23 21 21 68 22.7 Medium 57 57 55 55 56 56 168 56.0 .648 .958 The last 19 19 22 22 23 23 64 21.3 N.S

Marital status: Single 73 73 96 96 14 14 183 61.0 Married 24 24 3 3 86 86 113 37.7 161.041 .000 Divorced and widow (ed) 3 3 1 1 0 0 4 1.3 S

Nabila Taha, et al. 513

Table (2): Distribution of the students according to their body image perception.

Country

Body image KSA Egypt (100) (100)

Yemen (100)

Total (300)

Chi-Square Test

Positive perception 86 (86%) 84 (84%)

Negative perception 14 (14%) 16 (16%)

73 (73%)

27 (27%)

243 (81%)

57 (19%)

6.368

p .041 S

Table (3): Distribution of the subjects according to self esteem.

Country Total (300)

Chi-Square Test

Self esteem KSA (100) Egypt (100) Yemen (100)

Low self esteem 22 4 22% 4%

High self esteem 78 96 78% 96%

16 16%

84 84%

42 14%

258 86%

13.953 p .001

S

The relation between self esteem and body image among the studied students is clarified in Table (4), it was found that 85.9%, 84.4% and 69.0% of the subjects with a high self esteem had positive body image among the studied students in KSA, Egypt and Yemen respectively, with a statistically significant difference (X 2=13.58, p=.001) between groups, while 75.0%, 84.8% and 93.8% of the subjects with a low self esteem had positive body image among the studied students in Saudi, Egypt and Yemen respectively, with no statistically significant differences.

Comparison between sociodemographic char- acteristics in relation to body image in the three countries was presented in Table (5). It was found that students' age from 20-25 years is correlated positively with positive perception of the body image among students of KSA, Egypt and Yemen (94.2%, 65.5% and 86.3%) respectively with a highly statistical significant differences between groups (X2=34.75, p=.000). Fortunately mother's

education, urban areas, mediated family income, birth order among sisters and brothers and marital status all are associated with positive perception of body image with a highly statistical significant differences between groups owing this to the communities differences.

Concerning the comparison between socio- demographic characteristics in relation to self- esteem in the three countries Table (6) presented that, students' age from 20-25 years is correlated positively with high selfesteem among students of the thre countries KSA, Egypt and Yemen (89.7%, 69.8% and 85.7%) respectively with a highly statistical significant differences between groups (X 2=31.98, p=.000). Fortunately moth- er's job, urban areas, mediated family income, number of sisters and brothers and marital status all are associated with high self esteem with a highly statistical significant differences between groups.

Table (4): Relation between self esteem and body image.

Student self esteem

High self esteem Low self esteem Student body image

Saudia (78)

Test Egypt (96) Yemen (84)

χ 2 Saudia (22) Egypt (4) Yemen (16)

N

%

N

%

N

% N

%

N

%

N

%

Positive perception 67 85.9 81 84.4 58 69.0 13.58 19 75.0 3 84.8 15 93.8

Negative perception 11 14.1 15 15.6 26 31.0

p=.001 S

3 25.0 1 51.6 1 6.2

514 Comparison between Body Image & Self-Esteem Among Female Nursing Students

Table (5): Comparison between students’ sociodemographic characteristics in relation to the three Arab Countries.

Student body image

Socio-demographic Characteristics

Positive perception

Test x 2

Negative perception

Al-Riyadh (86)

Assiut (84)

Yemen (73)

Al-Riyadh (14)

Assiut (16)

Yemen (17)

N % N % N % N % N % N %

Age (years): <20 4 4.7 29 34.5 7 9.6 34.75 0 0 3 18.8 0 0 20- 81 94.2 55 65.5 63 86.3 p=.000 10 71.4 13 81.3 25 92.6 25-30 1 1.2 0 0 3 4.1 S 4 28.6 0 0 2 7.4

Mothers education: Illiterate 15 17.4 23 27.4 15 20.5 19.23 5 35.7 5 31.3 6 22.2 Basic 30 34.9 28 33.3 41 56.2 p=.004 6 42.9 4 25.0 12 44.4 Secondary 19 22.1 23 27.4 10 13.7 S 1 7.1 5 31.3 3 11.1 University 22 25.6 10 11.9 7 9.6 2 14.3 2 12.4 6 22.2

Fathers education: Illiterate 7 8.1 11 13.0 4 5.5 11.65 4 28.6 2 12.4 2 7.5 Basic 32 37.2 26 31.0 32 43.8 p=.070 2 14.3 5 31.3 6 22.2 Secondary 22 25.6 26 31.0 28 38.4 N.S 6 42.9 4 25.0 12 44.4 University 25 29.1 21 25.0 9 12.3 2 14.3 5 31.3 7 25.9

Mothers job: Housewife 61 70.9 65 77.4 65 89.0 7.81 12 85.7 12 75.0 24 88.9 Employed 25 29.1 19 22.6 8 11.0 p=.020S 2 14.3 4 25.0. 3 11.1

Place of Residency: Urban 84 97.7 30 35.7 61 83.6 87.85 9 64.3 5 31.3 26 96.3 Rural 2 2.3 54 64.3 12 16.4 p=.000S 5 35.7 11 68.7 1 3.7

Family income/month: Sufficient 2 2.3 0 0 24 32.9 58.03 3 21.4 0 0 7 25.9 Mediate 68 79.1 76 90.5 44 60.3 p=.000 11 78.6 16 100 17 63.0 Insufficient 16 18.6 8 9.5 5 6.8 S 0 0 0 0 3 11.1

Number of daughters and sons:

Null 3 3.5 0 0 2 2.7 27.22 0 0 0 0 0 0 1-3 2 2.3 21 25.0 22 30.1 p=.000 1 7.1 2 12.5 3 11.1 4-6 44 51.2 39 46.4 30 41.1 S 7 50.0 13 81.3 16 59.3 More than 7 37 43.0 24 28.6 19 26.0 6 42.9 1 6.3 8 29.6

Birth order: First 19 22.1 20 23.8 17 23.3 1.12 5 35.7 3 18.8 4 14.8 Medium 51 59.3 46 54.8 38 52.1 p=.891 6 42.9 9 56.2 18 66.7 The last 16 18.6 18 21.4 18 24.7 N.S 3 21.4 4 25.0 5 18.5

Marital status: Single 65 75.6 81 96.4 12 16.4 124.08 8 57.1 15 93.7 2 7.4 Married 19 22.1 2 2.4 61 83.6 p=.000 5 35.7 1 6.3 25 92.6 Divorced and

widow (ed) 2 2.3 1 1.2 0 0 S 1 7.1 0 0 0 0

Nabila Taha, et al. 515

Table (6): Comparison between students’ sociodemographic characteristics in relation to selfesteem in the three different Arab Countries.

Student self esteem

Socio-demographic Characteristics

Low self esteem

Test x 2

High self esteem

Al-Riyadh (22)

Assiut (4)

Yemen (16)

Al-Riyadh (78)

Assiut (96)

Yemen (84)

N % N % N % N % N % N %

Age (years): <20 1 4.5 3 75.0 0 0 22.22 3 3.8 29 30.2 7 8.3 20- 21 95.5 1 25.0 16 100 p=.000 70 89.7 67 69.8 52 85.7 25-30 0 0 0 0 0 0 S 5 6.5 0 0 5 6.0

Mothers education: Illiterate 2 9.1 0 0 0 0 14.71 18 23.1 28 29.2 21 25.0 Basic 11 50.0 1 25.0 15 93.7 p=.023 25 32.1 31 32.3 38 45.2 Secondary 3 13.6 2 75.0 0 0 S 17 21.8 26 27.1 13 15.5 University 6 27.3 1 25.0 1 6.3 18 23.1 11 11.5 12 14.3

Fathers education: Illiterate 1 4.5 1 25.0 0 0 13.39 10 12.7 12 12.5 6 7.1 Basic 9 40.9 0 0 13 81.3 p=.037 25 32.1 31 32.3 25 29.8 Secondary 9 40.9 2 50.0 2 12.5 S 19 24.4 28 29.2 38 45.2 University 3 13.7 1 25.0 1 6.3 24 30.8 25 26.0 15 17.9

Mothers job: Housewife 14 63.6 2 50.0 14 87.5 3.58 59 75.6 75 78.1 75 89.3 Employed 8 36.4 2 50.0 2 12.5 p=.167 N. S 19 24.4 21 21.9 9 10.7

Place of Residency: Urban 20 90.9 1 25.0 10 62.5 9.32 73 93.6 34 35.4 77 91.7 Rural 2 9.1 3 75.0 6 37.5 p=.009 S 5 6.4 62 64.6 7 8.3

Family income/month: Sufficient 2 9.1 0 0 0 0 4.02 3 3.8 0 0 31 36.9 Mediate 18 81.8 4 100 16 100 p=.403 61 78.2 88 91.7 45 53.6 Insufficient 2 9.1 0 0 0 0 N.S 14 17.9 8 8.3 8 9.5

Number of sisters and brothers:

Null 3 13.6 0 0 0 0 22.69 0 0 0 0 2 2.4 1-3 0 0 0 0 10 62.4 p=.001 3 3.8 23 24.0 15 17.8 4-6 11 50.0 2 50.0 3 18.8 S 40 51.3 50 52.0 43 51.2 More than 7 8 36.4 2 50.0 3 18.8 35 44.9 23 24.0 24 28.6

Birth order: First 3 13.6 1 25.0 1 6.3 2.85 21 26.9 22 22.9 20 23.8 Medium 13 59.1 3 75.0 9 56.2 p=.583 44 56.4 52 54.2 47 56.0 The last 6 27.3 0 0 6 37.5 N.S 13 16.7 22 22.9 17 20.0

Marital status: Single 17 77.3 4 100 0 0 11.04 56 71.8 92 95.8 0 0 Married 5 22.7 0 0 5 31.3 p=.004 19 24.4 3 3.1 9 10.7 Divorced and

widow (ed) 0 0 0 0 11 68.7 S 3 3.8 1 1.0 75 89.3

Discussion

Over the past ten to twelve years, there has been an increase of study in the area of self esteem; self-esteem is the judgment of worth an individual assigns to his or her self [11] . In the areas of self concept and self esteem there has been a particular emphasis on college students in their second years

of studies. In this population self esteem appears to correlate with body image, the overall perception on individual has about their physical body [12] .

The aim of this study was to assess and compare the level of body image and self esteem of the females nursing students in three different Arabic countries (KSA, Egypt and Yemen).

516 Comparison between Body Image & Self-Esteem Among Female Nursing Students

The study results have shown that 79.8% of the female with positive body image had high self esteem; this finding expresses a strong relationship between body image and self esteem. This is in agreement with Friedman and Haaga [13] who found in their research that, the participants who endorsed more depressive symptoms and reported lower levels of self esteem used proportionately more negative terms when describing themselves. Moreover, Dimitra [14] says that, for many women self esteem is based executively on their body image. On the other hand Trampe [15] , supported the negative effects “these perfect images have ones’ self esteem.”She found in her study that, the more body dissatisfied women were the more they indicated that they compare their body with that of other women. It follows that if in fact these images can change the way women feel about themselves over time, they can be even more dam- aging to anyone who is already dissatisfied with his/her body. Mean while Killi [16] found a weaker relation between body image dissatisfaction and self esteem.

The current study revealed that, the majority of the subjects were with positive body image, there is a contribution to this finding, in which most of Arabic females usually tend to reject ex- ternal standards of beauty, essentially in an effort to protect their self esteem, by the virtue of satis- faction which is acquired from the religion, the Arabic females have been described as “working with they have” instead of trying to obtain the ideal beauty presented by the media, So they tend to positively accept their body as it is.

In relation to the level of self esteem, high level of self esteem 96% was observed in the study sample of Egypt followed by Yemen 84% then KSA 78%, It may contributed to the nature of society in both Riyadh (KSA) and Yemen which is a male dominant society, and the female consid- ered as dependant and follower to the male and in most occasions she losses her identity which will negatively affect her self esteem. This comes in line with Lightstone [17] , who said that self esteem can be ever change and is not created based on fact but influenced by environmental, physical and physiological experiences; it is not inborn but learnt. The learning comes from family and peers but only reinforces what is learnt and experience culturally.

Concerning the socio-demographic character- istics of the study sample, the findings illustrated that the percentage of the students with a positive body image is more higher than the percentage of

the students with a negative body image and were found between 20 to less than 25 years old. This result isn't in accordance with Yuerk et al. [18] who found no effect of age on the level of body image, but it is contradictory with other studies where they find a relation between age and body image [19] , and Arnet [20] , suggested that individuals experience some identity confusion during the middle adulthood (20-30 years), during this time females between the ages of 20-24 years old may feel negative body image about themselves.

As regards to the father’s and mother’s educa- tion, the study showed that, the percentage of fathers and mothers who had basic education were higher between subjects with a low self esteem, it may be due to the lack of satisfactory level of education which may affect the personality of the parents and the way of communications they used to relate with their daughters as a consequence it will affect the subject’s way of thinking about the self concept and self esteem.

Regarding the marital status in relation to body image, the present study found that, the single students constituted (65%,96.4% and 16.4%) of students who have positive body image of KSA, Egypt and Yemen students respectively with a highly statistical significant difference between them, (X2 =124.08, p=.000) compared to (57. 1, 93.7% and 7.4% of the married females who had negative body image. This finding is contradicting with the Dimitra [14] , findings which indicated that, marital status was related significantly with body image, married women having a more positive body image than women that were single, divorced or widowed. On the same line Spencer [21] found that married women accept more and view their bodies better than the women who are not married.

Concerning the number of brothers and sisters in the family, the findings of the present revealed that most of the students who had 4-6 brothers and sisters were with a high self esteem. This comes in line with Dimitra [14] , who stressed that the different sources of social support (family members, parents, and friends) they all seemed important in developing healthy body image and self esteem.

Conclusion: In conclusion high level of self esteem posi-

tively correlated with body image.

Hence, female students with lower self-esteem were more likely to be at risk of negative body image. Age, parent’s education, marital status, numbers of brothers and sisters, all are significantly correlated to body image and self esteem.

Nabila Taha, et al. 517

Recommendations: This study recommended: • Another informative study is advised to investigate other dimensions of body image and self esteem in multi-dimensional setting. • Studying the healthy lifestyle choices which are

also a key to improve body image.

Acknowledgement: We would like to acknowledge the help of our

nursing students of the three Arab countries for their valuable participation.

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